Field of the Invention
The present invention relates to surgical instruments and methods of their use, and more particularly to minimally invasive surgical instruments and methods incorporating working tool disposed within a needle and configured so that the needle extends and retracts over the working tool.
Description of Related Art
Over the last two decades, minimally invasive surgery has become the standard for many types of surgeries which were previously accomplished through open surgery. Minimally invasive surgery generally involves introducing an optical element (e.g., laparoscopic or endoscope) through a surgical or natural port in the body, advancing one or more surgical instruments through additional ports or through the endoscope, conducting the surgery with the surgical instruments, and withdrawing the instruments and scope from the body. In laparoscopic surgery (broadly defined herein to be any surgery where a port is made via a surgical incision, including but not limited to abdominal laparoscopy, arthroscopy, spinal laparoscopy, etc.), a port for a scope is typically made using a surgical trocar assembly.
The trocar assembly often includes a port, a sharp pointed element (trocar) extending through and beyond the distal end of the port, and at least in the case of abdominal laparoscopy, a valve on the proximal portion of the port. Typically, a small incision is made in the skin at a desired location in the patient. The trocar assembly, with the trocar extending out of the port, is then forced through the incision, thereby widening the incision and permitting the port to extend through the incision, past any facie, and into the body (cavity). The trocar is then withdrawn, leaving the port in place. In certain circumstances, an insufflation element may be attached to the trocar port in order to insufflate the surgical site. An optical element may then be introduced through the trocar port. Additional ports are then typically made so that additional laparoscopic instruments may be introduced into the body.
Trocar assemblies are manufactured in different sizes. Typical trocar port sizes include 5 mm, 10 mm, and 12 mm, which are sized to permit variously sized laparoscopic instruments to be introduced therethrough including, e.g., graspers, dissectors, staplers, scissors, suction/irrigators, clamps, forceps, biopsy forceps, etc. While 5 mm trocar ports are relatively small, in some circumstances where internal working space is limited (e.g., children), it is difficult to place multiple 5 mm ports in the limited area. In addition, 5 mm trocar ports tend to limit movement of instruments inside the abdominal cavity to a great extent.
Further, while laparoscopic surgery has reduced the trauma associated with various surgical procedures and has concomitantly reduced recovery time from these surgeries, there always remains a desire in the art to further reduce the trauma to the patient.
One area of trauma associated with laparoscopic surgery identified by the inventor hereof as being susceptible of reduction are the scars which result from the trocar ports used. In many laparoscopic surgeries, three or more trocar incisions are made. For example, in laparoscopic hernia repair surgery, four trocar incisions are typically made, with one incision for insufflating the abdomen and inserting the optical device, two incisions for trocar ports for inserting graspers therethrough, and a fourth port for passing a stapler therethrough. Those skilled in the art and those who have undergone surgical procedures that even the 5 mm trocar ports leave holes which must be stitched and which result in scars. Scar tissue may affect the internal portion of the fascia as well as the cosmetic appearance of the skin, which may be detrimental for the patient or even a surgeon if that area of the skin is subject to a later incision or medical procedure.
A second area of trauma associated with laparoscopic surgery relates to trauma resulting from the manipulation (e.g., angling) of the trocar ports required in order to conduct the surgery due to inexact placement. Angling of the port can cause tearing at the incision periphery. Such tearing can lead to extensive scar tissue and in general an extension of the incision area.
A further problem with surgical instruments including a needle tip is inadvertent needle penetration in tissue and resulting scarring or even more serious complications during the surgery if other tissue is nicked or penetrated unintentionally. Therefore a need exists for a surgical instrument or device with an end-effector which controls the needle tip as well.
There continues to be a need in the art for lower cost laparoscopic tools and surgical assemblies which have improved applications, reduce trauma to the patient, reduce complications to the patient, do not lead to extension of the incision area, do not lead to increased scar tissue generation, are easy to make and use, and improve safety while reducing costs to health care providers and patients and reducing the surgical time for a procedure which in turn may reduce costs and complications. The inventive device includes a self-inserting needle assembly which closes over a working tool or end effector, such as a grasping assembling, and thus there is no need for a trocar or other incision point thereby reducing time during the surgical procedure and scarring to the patient at the point of incision.
While conventional needle assemblies including a grasping assembly are known, the conventional art has the grasping assembly actuated by a plunging force out of the needle assembly and retracting back into the needle assembly which may cause tearing of the tissue as the grasping assembly may rotate freely once actuated and out of the needle assembly. Further, when the working tool, of instance a grasping assembly, is fully retracted in the conventional devices, the needle tip may inadvertently penetrated tissue or organs unintentionally. Thus there exists a need for a grasping assembly which is not freely rotational while in use and grasping tissue or other materials. These and other needs are met by the inventive device and method.
Other advantages of the present invention will become apparent from the following description and appended claims.